Most of the outcome studies we examined used a

rigorous methodology and rated highly for sample
formation, adjusting for differences between the
groups, and the objectivity of the outcomes being
measured. However, they rarely considered the full
implications of using the patient as the unit of analysis
rather than randomising work units (such as practices).
This may reflect the difficulties of researching a
technology with which we are striving to keep up. Allo-
cation by practice reduces the confounding effect of
participating in research on those researched. How-
ever, computerisation in primary care is so widespread
that finding practices which do not have the specific
system feature to be evaluated as well as adequate con-
trols is virtually impossible. Randomising practices to
receive particular systems is also problematic. Not only
is this expensive, but it often seems inconsequential; no
sooner has the system been evaluated than it has been
modified or updated and requires further evaluation.

The most fruitful areas of current research are pre-

ventive care, prescribing support, chronic disease
monitoring, test ordering, and hospital referral. Few
studies have dealt with nursing research in general
practice, and little has been published on the impact of
computer systems on other members of the primary
care team.

Conclusions
It is over three decades since information technology
was first introduced to primary care. In the 1960s its
use centred on collating patient data; in the ’70s the
possibility of electronically linking primary and
secondary care emerged; in the ’80s computers were
introduced to the consulting room; and in the ’90s the
internet provided the potential to obtain and review
useful information during the consultation. After 30
years of analysing the “potential” benefits of comput-
ers, perhaps we should allow information technology
in primary care to mature. In the 21st century we
should accept that the computer is a useful tool. Rather
than continually describing its capabilities, research
must move forward to evaluate key outcomes for
patients, practices, and the health service as a whole.

12

The results of this systematic review are also available in a MS
Access database, which can be obtained on disk from E Mitchell.

We thank everyone who provided us with information for this
review. We thank the expert panel who participated in our Del-
phi study, which we know was time consuming. We also thank Dr
Sue Ross for her advice and Michere Beaumont for secretarial
support.

Contributors: EM conducted the Delphi study, designed the

review protocol and search strategy, conducted the literature
retrieval, reviewed all abstracts identified, read all potentially rel-
evant articles, scored all articles included in the review, and
wrote the initial draft of the paper. FS reviewed all abstracts
identified, read all potentially relevant articles, scored all articles
included in the review, and contributed to and edited the paper.

Funding: This study was funded by a grant from the Chief

Scientist Office of the Scottish Executive Health Department
(K/OPR/2/2D300).

Competing interests: None declared.

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(Accepted 18 September 2000)

What is already known on this topic

For most primary care consultations in Britain and elsewhere in the
developed world, computers are available

When a computer is used during a consultation it can increase both
the medical content and length of that consultation

What this study adds

Despite the rapidly changing nature of this technology and its
capabilities, research has concentrated on preventive care and
prescribing, with few studies evaluating patient outcomes

Research has centred on general practitioners, and little has been
published on the impact of computers on other members of the
primary care team

The main concerns of practitioners and patients about primary care
computing are confidentiality, impact on the doctor-patient
relationship, cost, time, and training

Corrections and clarifications

ABC of diseases of liver, pancreas, and biliary system:
Investigation of liver and biliary disease
In this article by I J Beckingham and S D Ryder
(6 January, pp 33-6) the flow diagram illustrating
the investigation and referral of patients with
jaundice in primary care unfortunately offered two
management plans (instead of one) for patients
with bilirubin concentrations > 100 ìmol/l. The
box below the first downward arrow should read
“bilirubin <100 ìmol/l.”

Randomised controlled trial of homoeopathy versus
placebo in perennial allergic rhinitis with overview of
four trial series
A keyboard slip resulted in an error in table 2 of
this paper by Taylor and colleagues (19-26 August,
pp 471-6). The mean difference between groups
for evening nasal inspiratory peak flow should be
14.1 [not 12.1].

In-flight medical emergencies: an overview
In the section entitled “automatic external
defibrillators” in this article by Tony Goodwin
(25 November, pp 1338-41) it was wrongly stated
that Virgin Atlantic Airways was the first airline to
carry such equipment; in fact, British Caledonian
was the first, in 1986.

Information in practice

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